| Organization Name: | EDGEBROOK CARE CENTER |
| NPI Number: | 1003893447 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN DOUGHTY (ADMINISTRATOR) |
| Mailing Address: | 505 W Trosky Rd Edgerton |
| State: | MN US |
| Postal Code: | 561282748 |
| Phone Number: | 5074427121 |
| Fax Number: | 5074423952 |
| NPI Enumeration Date: | 12/28/2005 |
| NPI Last Update Date: | 12/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BN1400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Nursing Facility Supplies |
| Taxonomy Definition: | |